Monday, March 23, 2009
Bad Ideas Abound, And Here's Another One
Anyone with a chronic illness often easily transforms into an activist with a cause, particularly when one has a pressing ulterior motive to see the development of more effective treatments and even daring to dream for a cure. Since I struggle with mental illness myself, I am always on the lookout for news stories like this. Shocking though this article is, I have to tell you from personal experience such things are hardly uncommon.
I've seen firsthand what happens when psychiatric patients are thrown together with addicts in an acute hospital setting. The results are frequently unpleasant. Once I saw a fight break out between two patients, one psychiatric, the other addiction, over something as silly as an argument over a dinner roll. The quality of care suffers as well, particularly when nurses and staff have to referee potential altercations when monitoring patient conditions would be time better served. Thus, dumping mentally ill patients into nursing homes peopled largely with seniors who suffer from senile dementia and Alzheimer's is another very bad idea.
In the past, it was believed that those with severe mental illness had no chance of ever living a normal life. They were therefore institutionalized for years at a time, if not for the rest of their lives. This gave rise to the sanatorium and the iconic images of gardens, well-tended lawns, and a bucolic respite from the bustling city in the quiet of the countryside. Such things do not exist anymore. With more effective treatments available from both medication and therapy, these places were shut down. Still, just shutting down an institution doesn't mean that mental illness goes away.
There are still lamentable psychiatric conditions like schizophrenia, for example, that modern medicine still cannot effectively treat with much success. A goal of being able to live a normal life for someone who is delusional or severely psychotic is not very feasible. This is what has given rise to dumping mentally ill patients in nursing homes. Without a family willing to care for them or without a knowledge of more effective treatment options worthy of pursuing, the close family of someone with severe mental illness often believes that institutionalization in a nursing home is the only option remaining.
Many state mental hospitals, as mentioned in the article, have also closed their doors as well. This is largely a result of the fact that many were often poorly-funded, badly run, under-staffed, decaying with age, and thoroughly unpleasant for all. The state of Alabama maintains Bryce Hospital in Tuscaloosa, but its barbaric conditions have been well-documented and the most it keeps a patient at any time is ninety days by court order. This creates a severe problem when patients spend three months inside, are released, have nowhere to go, live life on the streets as a homeless person, are rearrested, and then summarily sent back to Bryce. For many, this process is a revolving door that continues for years, never satisfactorily resolved.
Psychiatric beds in conventional hospitals are often in short supply, since in-patient hospitalizations for mental illness have increased with time. This creates a multitude of problems but two of them, in particular, are that patients are summarily pushed out and discharged before they are well enough; the other is that when beds do not exist at a psychiatric hospital or psychiatric unit of a conventional hospital, caretakers look for other options, nursing homes being a major one.
No system is perfect, but we could certainly be doing much better than we are. Much misinformation exists about mental illness, particularly among the undereducated and the poor.